Bringing a new pharmaceutical product to market can be challenging, to say the least. The process from discovery through human trials and finally to commercialization takes many years, at an average cost of $2.6 billion, according to a 2019 study by the Tufts Center for the Study of Drug Development. The ability to gain access to new drugs once they’re approved is critical for both manufacturers and patients.
And yet, for all this effort, there is no guarantee that a drug product — even one with fantastic clinical data — will gain traction, prove its worth, and get to patients who need it. Why?
Look, in part, to the inherent dysfunction in the U.S. health care system. Payers and employers rely on an increasingly complex system of countermeasures, including prior authorization, step therapy with intensive documentation, economic hurdles, and many other access challenges. Formulary restrictions and cost-sharing are also well-known barriers to access.
When launching a new product, every manufacturer understands the value in building trust and confidence with providers and patients. Ultimately, the goal is for patients to have access to innovative therapies and confidence in the process of obtaining their medications. Transparency of benefit design is key.
Real-time benefits checks are an ideal solution to expanding accessibility. Using simple patient inputs to provide a customized view of specific coverage restrictions and out-of-pocket cost obligations, real-time benefits checks empower patients and providers to make informed decisions about care.
Let’s look at the advantages of real-time benefits checks from three perspectives: those of the patient, the provider, and the manufacturer.
For the patient: reducing the confusion
Of the three stakeholder groups, patients suffer most directly from confusion about prescription benefit coverage. Their confusion is compounded when prescribers and pharmacists are also confused as to how much a medication will cost a patient or why it is priced the way it is for one person and differently for another. Out-of-pocket costs are a deterrent to a patient’s willingness to try or stay with a branded medication. And it’s not just the actual dollar cost that causes confusion. Benefit designs like deductibles and prior authorizations, coupled with a lack of clear communication about them, contribute to the problem.
Mismatched expectations are another deterrent to treatment. It’s not uncommon for a person with robust benefits to show up at the pharmacy counter and be surprised either by the cost of a drug or the news that it’s not covered. It’s not that people are ignorant of their coverage. It’s that in a landscape where no two benefit designs are the same — not even under the same payer, plan, or employer — the issue of health-benefit literacy is inevitable. Most patients don’t have access to professionals to help them understand their pharmaceutical benefits or options.
That’s where real-time benefits checks can help. Real-time benefits checks provide the patient with on-demand drug price transparency with the option to obtain payment assistance in the form of a copay program. With just a few simple inputs, a real-time benefits check can reveal such information as how many dollars remain on a patient’s deductible and what savings options may be available. Clear, concise communication can build trust between patients and healthcare professionals, provide transparency, and direct patients to programs that make more-expensive medications accessible to them.
For the health care provider: easing the frustration
Through the practice of good medicine, the prescriber drives adoption of new medications in the marketplace. The last thing any healthcare professional wants is to carefully choose a medication for a patient, only to have the patient not fill the prescription because of its cost. If a provider writes 10 scripts for a new branded medication but 3 of the 10 patients call the office complaining that the doctor prescribed a medication they can’t afford, the frustrated prescriber will shift writing practices to appease patients.
Real-time benefits checks provide a way for prescribers to identify exact patient out-of-pocket costs at the point of prescribing. This can take place either by way of integration with the electronic health record or a web interface for the office staff. The transparency provided by real-time benefits checks helps prescribers to communicate deductible challenges to patients, drives trials of new medications, and can assist with completion of prior authorizations.
For the manufacturer: supporting a successful launch
Manufacturers bring new medications to patients in what is an increasingly competitive landscape. Talented brand managers analyze markets, trends, and competitive products’ lifecycles and build sophisticated programs to bring a product to market. Real-time benefits checks can be leveraged to ensure that accessibility aligns with these program strategies. Depending on the market or brand strategy, manufacturers can deliver prescriber-focused or patient-facing tools that create price transparency, drive prescribing, and steer patients in need toward affordability and access programs. Ultimately, that means a minimized abandonment rate and increased fills. With real-time benefits checks on the brand’s website, patients can instantly access their out-of-pocket costs for the medication and learn about affordability programs available to them, all with the shared goal of getting the right medication to the right patients at the right time.
Real-time benefits checks offer a distinct advantage over benefits checks based on historical data, which are neither personalized nor keep up with ever-changing benefit designs. A well-thought-out program can enable prescribers to make confident, well-informed decisions, reduce the complexity of the patient journey, and align seamlessly with a brand strategy.